Post-Surgery Swelling in Lower Limbs: What to Expect After Hip Replacement

Postoperative lower limb edema

Hello Doctor, my father is 70 years old and underwent surgery to replace his left hip joint with a health insurance-covered artificial hip on February 22 of this year due to hip joint degeneration.
It has been almost two months since the surgery, but his left lower limb has been consistently swollen without any pain.
Is this normal, or is there something we should be concerned about? Thank you.

Xiao Bao, 70~79 year old female. Ask Date: 2021/04/21

Dr. Cai Shanglin reply Orthopedics

Hello, Xiaobao user.
It has been two months since your hip joint surgery, and you are still experiencing lower limb swelling.
If the swelling occurs only in the afternoon or evening and not in the morning, it is more likely to be positional, and increased activity may help improve it.
However, if the swelling is present throughout the day, you should be cautious as it could indicate a venous thromboembolism.
Please consult your physician for an evaluation during your next appointment.
Wishing you good health.

Reply Date: 2021/04/21

More Info

After a hip replacement surgery, it is not uncommon for patients to experience some degree of swelling in the lower limbs, particularly in the leg that underwent the procedure. This swelling, known as edema, can occur for several reasons and is generally considered a normal part of the healing process. However, it is essential to monitor the situation closely and understand what to expect during recovery.

Normal Post-Surgery Edema
1. Inflammatory Response: After surgery, the body initiates an inflammatory response to promote healing. This response can lead to increased blood flow and fluid accumulation in the tissues surrounding the surgical site, resulting in swelling.

2. Gravity Effects: When a patient is in a sitting or standing position, gravity can cause fluid to pool in the lower extremities, especially if the patient is not moving around much. This is particularly true for older adults or those who have limited mobility post-surgery.

3. Surgical Trauma: The surgical procedure itself can cause trauma to the tissues, leading to localized swelling. This is often more pronounced in the first few weeks after surgery and may gradually decrease as healing progresses.

When to Be Concerned
While some swelling is expected, there are certain signs that may indicate a need for further evaluation:
1. Severe Swelling: If the swelling becomes significantly worse or is accompanied by pain, redness, or warmth, it could indicate a complication such as a blood clot (deep vein thrombosis) or infection.

2. Persistent Swelling: If the swelling does not improve over time or continues to worsen after several weeks, it is advisable to consult with the healthcare provider.

3. Changes in Mobility: If the swelling is accompanied by a decrease in mobility or an inability to bear weight on the affected leg, this should be addressed promptly.

Management Strategies
To help manage and reduce swelling in the lower limbs post-surgery, consider the following strategies:
1. Elevation: Elevating the affected leg above heart level can help reduce swelling by promoting fluid return to the circulatory system.

2. Compression: Wearing compression stockings or wraps can help prevent fluid accumulation and support circulation in the legs.

3. Movement: Engaging in gentle movements and exercises as recommended by a physical therapist can help improve circulation and reduce swelling. It is essential to follow the rehabilitation plan provided by the healthcare team.

4. Hydration: Staying well-hydrated can help maintain fluid balance in the body and support the healing process.

5. Monitoring: Keep an eye on the swelling and any accompanying symptoms. Regular follow-up appointments with the healthcare provider are crucial for assessing recovery progress.

Conclusion
In summary, mild swelling in the lower limbs after hip replacement surgery is generally normal and can be attributed to the body's healing process. However, it is essential to remain vigilant for any signs of complications. If your father is experiencing persistent swelling without pain, it is likely part of the recovery process, but maintaining open communication with his healthcare provider is crucial for ensuring a smooth recovery. Regular follow-ups and adherence to rehabilitation exercises will aid in his recovery and help manage any swelling effectively.

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